Symptomatic, Operable Tarlov Cysts: A Myth or a Reality?

The presence of perineural cysts within the sacral spinal canal was initially described in the literature as early as 1938, when Tarlov had identified a similar lesion during one of his autopsies [1]. These rare cerebro-spinal fluid-filled lesions arising from the nerve root sheaths of the dorsal root ganglion, have thence, been described by various authors with diverse clinical and radiological presentations [2]. While a majority of these lesions are asymptomatic [3], there have been described instances in the literature, when these lesions have resulted in symptoms such as low back or radicular pains, coccygodynia or cauda equina syndrome [3]. Since the pathogenesis of these lesions remains ambiguous [2], the ideal mode of management of these symptomatic cysts has remained controversial and poorly understood.